=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477416899
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNFILTERED THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2025
-----------------------------------------------------
Last Update Date | 12/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 700 NARRAGANSETT PARK DR STE 100
-----------------------------------------------------
City | PAWTUCKET
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02861-4326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-575-2481
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 700 NARRAGANSETT PARK DR STE 100
-----------------------------------------------------
City | PAWTUCKET
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02861-4326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-575-2481
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | JOHN THACH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 978-848-8337
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------